"A silver catheter was introduced into the bladder, and after drawing off the small quantity of urine which it contained, an attempt was made to distend the bladder by means of tepid water injected through the catheter; this, however, was very imperfectly accomplished, in consequence of the boy's violent struggles, and the forcible resistance made by the action of the abdominal muscles.

"An incision about two and a half inches long was now made through the skin and linea alba, terminating at the symphysis pubis; the fibres of the pyramidal muscles were then separated in the mesial line, and partly detached from their origin in the pubes. The handle of the catheter being now depressed, its point was made to project about three-fourths of an inch above the symphysis, and a sharp-pointed bistoury was then pushed into the bladder, immediately below the point of the catheter, and carried down towards the pubes, by which sufficient space was made for the admission of the finger. On its first introduction, nothing could be felt except the extremity of the catheter; but on turning the point of the finger upwards, the stone was felt impacted in the upper part, or fundus of the bladder, altogether above the brim of the pelvis, and wholly above the wound. Attempts were now made to seize the stone with the forceps, which repeatedly slipped, bringing away with them considerable fragments of the stone. It being obvious, that nothing was to be gained by prolonging the incision downwards, it was now dilated upwards, on the point of the finger; and the attempts to bring away the stone by the forceps, scoop, and fingers in the rectum, were persevered in for some time without success. The stone, however, was brought nearer to the external orifice, and retained in that situation by the finger in ano. No farther prolongation of the wound upwards (however desirable) could be attempted, the peritoneum having been already laid bare, and the intestine threatening to protrude. Under these circumstances, an attempt was made to gain a little space, by cutting transversely; and a few fibres of the bladder were divided in this direction on the right side, when the stone was extracted, with a moderate degree of force. A quantity of tepid water was now thrown forcibly into the bladder, and the fragments washed out. The edges of the wound were besmeared with oil, with a view of preventing, as much as possible, the insinuation and lodgment of urine in the cellular membrane. Two stitches were passed through the upper end of the incision, supported by a strap of adhesive plaster; its lower extremity was left open, covered only by a slip of simple dressing, and a compress of soft lint. An elastic gum catheter was lodged in the bladder, and the patient conveyed to bed, having been in all upwards of half an hour on the table. The stone was of an irregular plum shape; weighing, exclusive of many large fragments, thirteen drams and one scruple: measuring in its longitudinal diameter upwards of two inches, and in its transverse diameter one inch and a half. The fragments of the external layer, which were put into Dr. Turner's hands for analysis, contain some uric acid, but consist principally of mixed phosphate of lime and ammoniaco-magnesian phosphate." 261.

In the evening he was found to have much tenderness over the abdomen, with quick pulse, dry tongue, and hurried respiration. Leeches were applied near the wound, and some aperient ordered for next morning.

Next day the abdominal tenderness was diminished, and the urine flowed both from the catheter and the wound. But, by mid-day, matters changed greatly for the worse, and he died at 8 o'clock in the evening.

On dissection, there were found some marks of inflammation on the peritoneum, and a little bloody serum in the abdominal cavity. The opening in the bladder was nearly two inches long. The upper part of this viscus, embracing the stone, was found enveloped with strong muscular fibres, converging towards a point a little below the superior extremity of the wound. At this point the coats appeared thickened, and the internal surface of the bladder was highly vascular, and of a soft flocculent appearance. Below the place where the stone was lodged there was some disposition to organic contraction. Dr. Ballingall makes several remarks on the above case, for which we must refer to the work. His reasons for preferring the high operation in this instance, were-the magnitude of the stone-the peculiar situation which it occupied-and the possibility of being foiled in extracting it by the lateral operation. He feels himself at a loss to account for the calculus having originally formed a lodgment for itself in the fundus of the bladder.

Appended to this paper is a short communication from Mr. Russell, giving the particulars of a curious case, where a stone was lodged in the superior fundus of the bladder, which grasped the whole of the surface, excepting a small portion, about half an inch in diameter, opposite to the transverse axis. The bladder was most contracted at this point, beyond which it became more expanded, and formed the principal receptacle for the urine. The stone passed through the narrow neck of the bladder to the length of about three fourths of an inch. The bladder was thickened and contracted, and, near the centre of the upper fundus, there was an aperture nearly half an inch in diameter: but the stone was so firmly grasped by the bladder, at this part, as to prevent the urine from escaping into the cavity of the abdomen,

ART. VIII.

A Case of Disorganization of the Stomach of an Infant, with Pathological and Practical Remarks; intended as a Supplement to a former Paper on the same Subject. By JOHN GAIRDNER, M.D.

In the second volume of the present series, page 170, et seq. we gave an account of Dr. G.'s former paper on the above subject, while reviewing the first volume of these Transactions. Since that period, Dr. G. has seen only one decided case; but in it, the symptoms were so marked as to enable him, at the first glance, to recognize the existence of the disease. The subject was a boy, who was weaned at 11 months old, and, on the fifth day afterwards, was seized with diarrhoea, the stools being at first copious, green, slimy, and becoming watery in the course of the next two days. On the third day vomiting came on, with great thirst. These symptoms continued till the sixth day, when Dr. G. first saw the patient. There was then great emaciation-countenance expressive of anxiety-pulse 120skin hot-thirst urgent-fæces nearly natural in appearance. The indications of cure which seemed most proper to Dr. G. in this case were to allay irritation, and produce a quiescent state of the alimentary canal. The ingesta were ordered to be of the mildest kind, and small in quantity-the gums were divided over the two middle incisores-no medicine to be given. The next day (7th of the disease) the vomiting had ceasedthe diarrhoea, thirst, &c. much abated-the child seemed disposed to sleep. The regimen (half a wine-glassful of arrowroot every six hours) to be continued. The warm bath, if the heat should return.-8th day :-All the symptoms still more favourable. The same regimen. 9th day :-"All the morbid symptoms gone." The arrow-root as before. Dr. G. began to have some hopes of a cure; but on the following morning (10th day) the child had three dark fetid stools, solid, with some griping. This was the beginning of a diarrhoea, which was never afterwards thoroughly arrested. By the 15th day, it amounted to six stools in the twenty-four hours, and, by the 20th day, to 10 stools per diem. The child died on the 30th day of the disease. During this period he had vomited once or twice only; but he had lost all appetite, had great thirst, and was exceedingly fretful and restless. Paleness and occasional coldness of the extremities, with feeble pulse, indicated, from day to day an increasing languor of the circulation. The emaciation was progressive.

Dissection. Intestines more thin and translucent than usual. Some trifling fæcal matters in the jejunum and ileum, of a deep yellow hue. There was bile in the gall-bladder-mesenteric glands sound, as were the thoracic viscera. On examining the splenic extremity of the stomach, a semi-transparency and blueishness were observed at one point, which Dr. G. knew to proceed from disorganization of its texture, proceeding from within outwards. On examination of the interior, Dr. G. found all the coats perforated, except the peritoneal, which was so much attenuated as to give way under the pressure of a few drachms of fluid introduced into the stomach.

Remarks. We confess that this case surprized us a little. For Dr. G. informs us, that he recognized the nature of the disease on his first visit to the little patient, and "warned its parents of the impending danger." Yet, in almost the same breath, he lays down his indications of treatment on which he "rested his hopes of cure." Notwithstanding this impending danger, the child lived 24 days afterwards, and at one time in this period Dr. G. reported-" all the morbid symptoms gone." When we reflect on the symptoms described by Dr. G. as obtaining when he was first called in, we are really at a loss to know how he could, by them, recognize so formidable a malady as approaching disorganization of the stomach. Every practitioner meets with such symptoms daily, where no fatal issue takes place. Besides, when we recollect how quickly these circumscribed disorganizations of the stomach are produced, and how often they are seen in bodies, where no signs during life indicated their previous existence, we can hardly bring ourselves to believe that the affection of the coats of the stomach was the original cause of the symptoms. We are much more disposed to think that it arose in the course-perhaps near the close of the disease. The actual erosion, indeed, is considered by Dr. G. himself as a post-mortem process. "I am still of opinion that, whatever the changes may be which occur during life, the destruction of the stomach occurs after death, by the action of the fluids within upon its texture." The following observations respecting the subject of weaning, we deem worthy of insertion.

"1. The condition of the Patient.-If it has been liable to diarrhoea, or is a feeble child, emaciated by previous illness, weaning ought, if possible, to be avoided. If diarrhoea is actually present, the child should not on any account be weaned.

"2. The season of the year.-The disease seems to be most apt to happen in the hot weather of summer and autumn. In this the ex

perience of Cruveilhier, and I think of Jaeger also, agrees with mine. Mr. Burns states, that the four instances of disorganization of the stomach of infants, which he found in the dissecting-room, and of whose history, during life, he was ignorant, were all in the summer season. Dr. Cheyne, whose cases of atrophia ablactatorum closely resemble mine in many of their characters during life (though he does not appear to have detected the same appearances after death), expressly states, that the disease chiefly arises in the autumn.' I do not find that any cases, similar to that described above, have ever occurred in winter.

3. The Sex of the Patient.-From the above case, and those registered in the table already referred to, it would appear that boys are more prone to the disease in question than girls. In some of the cases the sex has not been noted, but of eighteen in which it is noted, fourteen were boys and four girls." 337.

IV.

Voyage en Italie, fait en l'Année, 1820. Deuxième Edition, corrigée et augmentée de Nouvelles Observations faites dans un Second Voyage en 1824. Par le Docteur Louis VALENTIN, Chevalier des Ordres, &c. &c.

Dr. Louis Valentin's Travels in Italy, in the years 1820, and 1824. Second Edition.

"MEN run to and fro, and knowledge is increased." So says Holy Writ. But others have said-" multum mentitur qui multum vidit;" and this we fear is too true. As far as our profession is concerned, the general impression is, that the travels of a well-informed physician may prove very advantageous to his native country, This must have been the impression on Dr. Radcliffe, when he bequeathed 500 pounds per annum for the support of a medical traveller-ship-and the impression has been kept up, of course, by the treasures of medical lore, which have been poured into this country quinquennially from the budgets of the "professors of travelling," thus fed and clad by the pious bequest of the Oxonian patriot. Whether a fixed salary for doing a certain duty be a better stimulus towards its performance, than the hope of gain or fame to be acquired by individual exertion, it is not for us to determine. Neither is it our intention to institute any comparison between

"Vol. i. Essay, 2. p. 29."